Browsing by Subject "homeless"
Item HEALTH PROFESSIONALS’ ATTITUDES TOWARDS THE HOMELESS(2014-03) Burdex, Ashley; Nejtek, Vicki; Talari, Deepika; Koehl, StevenPurpose (a): About 50% of Tarrant County homeless (n=2,123) have co-occurring medical disorders, receive inconsistent medical care, are at high risk for repeated crisis care hospitalization, and are often discharged prior to full stabilization.1,2 Whether or not medical crisis recidivism is influenced by clinical attitudes towards treating the homeless is uncertain. Here, we examined medical student, resident, and physician attitudes about the homeless condition and treating homeless patients. We hypothesize that medical students MS 1-4, residents, and physicians significantly differ in their attitudes in treating homeless patients. Methods (b): A prospective, cross-sectional between-group comparison of the attitudes towards treating homeless patients among medical school students, residents, and physicians (n=238) was conducted. Data were analyzed using analysis of variance (ANOVA) and Chi-square procedures. Statistical significance was determined using a 95% confidence interval and a probability alpha of 0.05. Results (c): The MS 1-2, residents, and physicians showed more empathy and had a higher interest in treating homeless patients than MS 3-4 (p=0.004). In contrast to other groups, MS 3-4 regard homeless people as lazy (p=0.001) and rude (p=0.028). Compared to medical students, physicians and residents believe that health dollars should be directed toward serving the poor and homeless (p=0.001). In comparison to physicians, MS 3-4 do not perceive homelessness as a health issue (p=0.002), and all medical students judged that government should not waste money on homelessness (p=0.001). Further, compared to other groups (especially physicians), MS 3-4 reported that alcoholism is a personal weakness (p=0.003) rather than a medical illness and think that clinicians should only address physical and not social problems (p=0.014). Conclusions (d): Overall, MS 3-4 are significantly more cynical and judgmental about the homeless condition and treating homeless patients than any other group. The lack of biological insight about the medical needs of the poor and homeless expressed by MS 3-4 is truly concerning. These data indicate a critical need for specialized education that will better inform medical students about socioeconomic conditions that significantly influence medical disease onset, etiology and prognostic outcomes in this vulnerable, complex, and difficult-to-treat patient population.Item MULTIPLE FRUIT-FLAVORED ALCOHOLIC DRINK IN A CAN (MFAC) USE AMONG SUBSTANCE USING ADULTS ON PROBATION(2014-03) Rossheim, Matthew E.; Rodgriguez, Mayra; Walters, Scott T.; Lerch, Jennifer; Taxman, Faye S.Purpose (a): Over the last decade, an emerging class of large, canned alcohol products (e.g. Four Loko, Joose, Blast) have been marketed in the U.S. Research suggests that consumption of these MFAC products could contribute to hazardous alcohol consumption. However, little is known about their consumption and related harm. Methods (b): In Dallas, TX and Baltimore, MD, 211 interviews were conducted with adults on probation who were participating in a larger clinical trial. Inclusion criteria included (1) being on probation, (2) being 18 years or older, (3) speaking English, and (4) either (a) using any illicit drug in the past 90 days or (b) consuming 5 alcoholic drinks (or 4 for women) on a single occasion in the past 90 days. Results (c): For our analyses, we sub-selected individuals with a recent history of alcohol consumption; 143 participants (68%) consumed alcohol in the past 30 days. This sample was mostly black (71%) males (64%). Among this sample, 22 (15.4%) had consumed an MFAC in the past 30 days. A nearly equal proportion of black and white, Hispanic and non-Hispanic, and male and female participants reported consuming these products in this time period. Interestingly, individuals who reported being homeless in the past 30 days were nearly twice as likely to consume an MFAC during this time period compared to those who were not homeless (32% vs. 12%). Conclusions (d): Because of their marketing, these products were thought to largely appeal to youth. Among a national sample of underage youth who consumed alcohol in the past 30 days, 8% (6-11%, 95% CI) reported consuming at least one MFAC in the past 30 days. Recent consumption of MFACs among our sample of high-risk substance using individuals on probation is even greater than these rates. Given the inexpensive cost of per unit of alcohol and large number of calories these products afford, it is possible that these products provide lower socio-economic individuals with added benefits. An examination of the types of users might add to a small literature on how such products are attractive to different groups. Further work might be needed to compare this to other groups or a nationally representative sample.Item Using machine learning to identify predictors of imminent drinking and create tailored messages for at-risk drinkers experiencing homelessness(Elsevier Inc., 2021-04-20) Walters, Scott T.; Businelle, Michael S.; Suchting, Robert; Li, Xiaoyin; Hebert, Emily T.; Mun, Eun-YoungAdults experiencing homelessness are more likely to have an alcohol use disorder compared to adults in the general population. Although shelter-based treatments are common, completion rates tend to be poor, suggesting a need for more effective approaches that are tailored to this understudied and underserved population. One barrier to developing more effective treatments is the limited knowledge of the triggers of alcohol use among homeless adults. This paper describes the use of ecological momentary assessment (EMA) to identify predictors of "imminent drinking" (i.e., drinking within the next 4 h), among a sample of adults experiencing homelessness and receiving health services at a homeless shelter. A total of 78 mostly male (84.6%) adults experiencing homelessness (mean age = 46.6) who reported hazardous drinking completed up to five EMAs per day over 4 weeks (a total of 4557 completed EMAs). The study used machine learning techniques to create a drinking risk algorithm that predicted 82% of imminent drinking episodes within 4 h of the first drink of the day, and correctly identified 76% of nondrinking episodes. The algorithm included the following 7 predictors of imminent drinking: urge to drink, having alcohol easily available, feeling confident that alcohol would improve mood, feeling depressed, lower commitment to being alcohol free, not interacting with someone drinking alcohol, and being indoors. The research team used the results to develop intervention content (e.g., brief tailored messages) that will be delivered when imminent drinking is detected in an upcoming intervention phase. Specifically, we created three theoretically grounded message tracks focused on urge/craving, social/availability, and negative affect/mood, which are further tailored to a participant's current drinking goal (i.e., stay sober, drink less, no goal) to support positive change. To our knowledge, this is the first study to develop tailored intervention messages based on likelihood of imminent drinking, current drinking triggers, and drinking goals among adults experiencing homelessness.